A prescription for saving our fiscal health?

Gov. Pat Quinn did last week what his bipartisan working group of legislators and others could not: He outlined a plan to cut $2.7 billion from the state's Medicaid budget.

This is gravely serious business that will affect many residents as well as hospitals, doctors, nursing homes and other providers. More than ever before, suburban residents are Medicaid users and our hospitals, doctors and others already are struggling financially.

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Still, Illinois has an $8.5 billion budget deficit and an even bigger pension debt. The time for putting off tough votes passed years ago. And the plan Quinn proposed isn't sugarcoated.

The governor proposes cutting health care services for about 215,000 people and limiting several services. He proposes a $675 million cut for providers, including hospitals and nursing homes. He proposes adding a $1-a-pack additional tax on cigarettes projected to generate $337.5 million from users and another $337.5 million in matching federal funds.

Frankly, we are more than sick and tired of Quinn turning to higher taxes and fees as a first recourse to the state's long-building and long-ignored financial problems. But, in this case, we will make an exception and support the increase. Illinois' elected leaders have been adding to our deadbeat status for too many years. That must stop now. A cigarette tax is not a reliable income source. It will shrink over time, but as it does so too will the costs we bear for smoking-related illnesses, and that will be welcome news. Those who condemn this plan because of a tax increase that represents one-eighth of the total package are engaging in political games we can no longer tolerate.

Quinn and his health care director, former suburban legislator Julie Hamos, are reaching for important goals with their plans. They aim to move more Medicaid beneficiaries into managed care and have been testing just such a program in the suburbs. They aim to crack down on fraud and use of the system by those who are not eligible. They admit they have not done that well. They aim to try to move more children into private insurance coverage.

They also aim to end prescription coverage for senior citizens, a practice already in place in many other states and one that could make sense given the creation a few years ago of federal prescription coverage.

This all is tough and frightening stuff. We worry about what the 8 or 9 percent cut to providers will do to our hospitals and health care workers. We urge the governor and legislators to consider other options for maximizing revenue such as an increase in the hospital assessment program. We urge them to take time to make sure they aren't going to boot needy seniors out of nursing homes or cut off their medication supply. We urge them to make sure they are auditing the results of these changes. We urge them to take time on complex issues like rate reform and which approach to managed care is best.

The devil is in the details. We're certain not all of these goals will work and some people who truly need help might not always get it. But drastic times call for drastic measures. This is a start at fixing a program that is a massive drain on taxpayers. Even if it were enacted tomorrow, providers still would wait four months for payment. We still will face a $1.9 billion backlog of unpaid bills.

"This is asking legislators to take a difficult vote," Hamos told us last week. Of all the ideas, she said, "Every single one offends somebody." And that is a start. It cannot be the end. It's time for legislators, providers and policymakers to hammer out significant change and compromise. Let this be the year those difficult votes are cast that put us all back on track to better physical, mental and fiscal health.

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